Antegrade resuscitative endovascular balloon occlusion of the aorta for impending cardiac arrest due to a ruptured abdominal aortic aneurysm in a hemodynamically unstable patient in Korea: a case report

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging intervention for noncompressible torso hemorrhage. We report the case of a 64-year-old man who presented with abdominal pain and hypotension due to a ruptured abdominal aortic aneurysm in South Korea. Upon clinical deterioration, temporary aortic occlusion was achieved using antegrade REBOA via the left brachial artery in the operating room. A balloon catheter was successfully placed proximal to the aneurysm using the Seldinger technique, resulting in rapid stabilization of vital signs. Definitive surgical repair with aortic replacement was then performed without complications. The patient fully recovered and was discharged 1 month later. This case demonstrates the clinical utility of antegrade REBOA when retrograde insertion is contraindicated, particularly in juxtarenal aneurysms. REBOA can provide a critical window for hemodynamic stabilization and surgical control in cases of life-threatening hemorrhage. Careful consideration of access site, balloon positioning, and imaging guidance is essential for safely and effectively deploying this technique.